[OSCE] Feverish child (Meningitis, Sepsis, UTI)

Question 1

What is the first line antibiotic for meningitis or meningococcal septicaemia in the community setting (e.g. GP)?

Answer 1

Benzylpenecilin

Question 2

What are the normal values of CSF?

Appearance
WCC (neutrophils and lymphocytes)
RCC
Protein
Glucose
pH
Opening Pressure

Answer 2

Appearance; Clear

WCC (all lymphocytes, NO Neutrophils); 0-5x10^6

RCC; 0-10x10^6

Protein; 0.2-0.4g/l

Glu; 3.3-4.4

pH; 7.31

OP; 70-180 mmHg

Question 3

A rise in which blood test marker may heighten your concerns of sepsis?

Answer 3

Lactate >4mmol/l

Question 4

What is the most appropriate treatment regime for meningitis?

Answer 4

Intravenous Ceftriaxone

Question 5

What changes to CSF analysis does bacterial meningitis produce?

Answer 5

Cloudy appearance

Raised WCC Neutrophils (100-10,000)

Raised Protein (>1g/l)

Very low glucose (<0.4)

[red cells are normal]

Question 6

What changes to CSF analysis does viral meningitis produce?

Answer 6

Raised WCC Lymphocytes (10-1000)

[Appearance, neutrophils, RCC, protein and glucose remain within normal values]

Question 7

What results may TB meningitis have on CSF result?

Neutrophils
Lymphocytes
Protein
Glucose (CSF:Blood ratio)

Answer 7

Raised WCC Lymphocytes (50-1000)

Raised protein (1-5g/l)

Very low glucose (<0.3)

[appearance, neutrophils, RCC remain normal]

Question 8

What are the common guilty organisms for meningitis in

Neonates - 3 months
3 months - 5 years
Over 5 years

Answer 8

Neonates - 3 months

• Group B Strep
• E.Coli
• Listeria

3 months - 5 years

• Neisseria Meningitides
• Strep Pneumonia
• Haemophilus Inf B

Over 5 years

• Neisseria Meningitides
• Strep Pneumonia

Question 9

What medication should be given with or before antibiotics in a meningitic patient?

How often and for how long is the course?

When is it too late to administer this medication?

Answer 9

Dexamethasone (before or with the first dose of antibiotics)

4x/day for 2-4 days

Too late if more than 12h lapsed since 1st Abx dose

Question 10

List 7 situations where you would NOT perform an LP on a child?

Answer 10

Unstable child (signs of shock or respiratory insufficiency)

Signs and symptoms of raised ICP

Suspected SOL (tumor)

After convulsions stabilised

Extensive or spreading pupuric rash

Bleeding disorder

Local infection at site of LP

Question 11

What are the clinical signs of leptospirosis and exposure to what element is classically attributed to it?

(hint: 3 Ps of lePtospirosis)

Answer 11

Purpura
Platelets
(pupils) Conjunctival Congestion

Exposure to contaminated water (sewage).

Question 12

What are Koplik spots pathogenomic of?

Answer 12

Measles

Question 13

What are the 4C’s of Measles?

Answer 13

Coryzal
Cough
Conjunctivitis
Cranky

Question 14

What is the most common complication of measles?

Answer 14

Otitis Media

Question 15

What are the common features of rubella?

Answer 15

You find a Macular rash and Suboccipital Lymphadenopathy in a 4 week old child.

There also seems to be some eye anomalies.

Question 16

What are the complications of Rubella at

<4 weeks
4-8 weeks
8-12 weeks

Answer 16

<4 weeks - Eye anomalies
4-8 weeks - Cardiac abnormalities
8-12 weeks - Deafness

Question 17

What are the signs of mumps?

Answer 17

Malaise
Raised Temperature
Parotid swelling, often becoming bilateral

Question 18

What physical signs are present in hand foot and mouth disease?

What is the causative pathogen and how do we treat this?

Answer 18

Vesicles on palms, soles and mouth

Coxsackie-virus or Enterovirus

Treat symptomatically

Question 19

What complication of pneumococcal meningitis is reduced with the administration of steroids?

Answer 19

Reduced hearing loss

Question 20

What three signs should concern you about meningitis/sepsis?

Answer 20

Fever + Lethargy + Vomitting

Question 21

How is Group B Haemolytic Streptococci commonly transmitted and how does it commonly present?

What is the treatment?

Answer 21

Via mother’s vagina
(swab mothers whos infants suddenly fall ill at ~24h-old)

Infection may be delayed by a month

Benzylpenecillin